The Durability of Endoscopic Therapy for Treatment of Barrett's Metaplasia, Dysplasia, and Mucosal Cancer After Nissen Fundoplication

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
Corey S JohnsonRalph W Aye

Abstract

Radiofrequency ablation (RFA) ± endoscopic resection (EMR) is an established treatment strategy for neoplastic Barrett's and intramucosal cancer. Most patients are managed with proton pump inhibitors. The incidence of recurrent Barrett's metaplasia, dysplasia, or cancer after complete eradication is up to 43 % using this strategy. We hypothesize the addition of fundoplication should result in a lower recurrence rates after complete eradication. Multi-institutional retrospective review of patients undergoing endotherapy followed by Nissen fundoplication A total of 49 patients underwent RFA ± EMR followed by Nissen fundoplication. Complete remission of intestinal metaplasia (CR-IM) was achieved in 26 (53 %) patients, complete remission of dysplasia (CR-D) in 16 (33 %) patients, and 7 (14 %) had persistent neoplastic Barrett's. After fundoplication, 18/26 (70 %) remained in CR-IM. An additional 10/16 CR-D achieved CR-IM and 4/7 with persistent dysplasia achieved CR-IM. One patient progressed to LGD while no patient developed HGD or cancer. Endoscopic therapy for Barrett's dysplasia and/or intramucosal cancer followed by fundoplication results in similar durability of CR-IM to patients being managed with PPIs alone after endoscopic...Continue Reading

References

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Citations

Dec 23, 2015·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Christina L GreeneSteven R DeMeester
Feb 24, 2016·Gastrointestinal Endoscopy·Rajesh KrishnamoorthiPrasad G Iyer
Jan 31, 2017·The Journal of Thoracic and Cardiovascular Surgery·Brian E Louie
Dec 22, 2017·World Journal of Surgery·Fernando A M HerbellaMarco G Patti
Apr 9, 2020·Annals of the New York Academy of Sciences·Luigi BonavinaRoger P Tatum
Jun 17, 2020·World Journal of Gastroenterology : WJG·Kara L Raphael, Arvind J Trindade
Jun 15, 2018·The American Journal of Gastroenterology·Tarek SawasDavid A Katzka

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